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Client Feedback Survey for Young Adult Coordinated Access Network Appointment

1.Date of appointment (mm/dd/yyyy): *
2.Does the young person agree to take the survey?(Required.)
3.Name of service provider you met with (Full Name): *
4.Location of appointment (Organization, City, and CAN Region) *
5.Coordinated Access Network Support Survey: (Please rate your overall experience working with the CAN staff by answering the following statements from a scale of 1 to 5. ) *
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly Disagree
The person who I met with was easy to talk to and understood my needs.
I was satisfied with the ease of getting a CAN appointment.
I was satisfied with my overall experience at the CAN appointment.
I felt that the person I met with is doing a good job to meet my needs.
I was actively included in all planning.
All staff were sensitive to my cultural/ethnic background.
CAN staff was knowledge about available resources.
6.Any additional comments or suggestions you would like to share?
Current Progress,
0 of 6 answered